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Email updates Keep up to date with the latest news and content from BMC Pregnancy and Childbirth and BioMed Central. Open Access Research article Labour management and Obstetric outcomes among pregnant women admitted in latent phase compared to active phase of labour at Bugando Medical Centre in Tanzania Clotrida Chuma1†, Albert Kihunrwa12†, Dismas Matovelo1*† and Marietha Mahendeka12 * Corresponding author: Dismas Matovelo [email protected] † Equal contributors Author Affiliations 1 Department of Obstetrics & Gynecology, Catholic University of Health & Allied sciences, P.O.BOX 1464, Mwanza, Tanzania 2 Department of Obstetrics & Gynecology, Bugando Medical Centre, P.O.BOX 1370, Mwanza, Tanzania For all author emails, please log on. BMC Pregnancy and Childbirth 2014, 14:68 doi:10.1186/1471-2393-14-68 The electronic version of this article is the complete one and can be found online at: biomedcentral/1471-2393/14/68 Received: 1 July 2013 Accepted: 6 February 2014 Published: 12 February 2014 © 2014 Chuma et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. Abstract Background Interventions given to women admitted in latent or active phase of labor may influence the outcomes of labor and ameliorate complications which can affect the mother and fetus. Labour management, maternal and fetal outcomes among low risk women presenting both in latent phase and active phase of labour in Tanzania have not recently been explored. Methods This was a descriptive cross-sectional study. It was done from February to April 2013. Case notes were collected serially until the sample size was reached. A structured checklist was used to extract data. Data was analyzed using SPSS version 17. A p < 0.05 was considered significant at 95% confidence interval. Results Five hundred case notes of low risk pregnant women were collected, half of each presented in latent phase and active phase of labour. Key interventions including augmentation with oxytocin, artificial rupture of membranes and caesarean section were significantly higher in the latent phase group than the active phase group 84(33.6%) versus 52(20.8%) p < 0.05; 96(38.6%) versus 56(22.4%) p < 0.05 and 87(34.8%) versus 60(24.0%) p < 0.05 respectively. Spontaneous vertex delivery was higher among pregnant women admitted initially in active phase than in latent phase groups 180(72.0%), versus 153(61.2%) p > 0.01). There were more women in the active phase group who sustained genital tract tear and postpartum haemorrhage than in the latent phase group 101(18.6%), versus 38(15.6%) p < 0.01 and 46(18.4%), versus 17(6.6%) p < 0.05 respectively. Conclusions Pregnant women admitted at BMC in latent phase of labour are subjected to more obstetric interventions than those admitted in the active phase. There is need to produce guidelines on management of women admitted in latent phase of labour at BMC to reduce the risk of unnecessary interventions. Keywords: Latent phase of labour; Active phase of labour; Interventions; Low risk pregnancy Background The first stage of labor encompasses the onset of labor to the complete dilatation of the cervix, and is subdivided into latent and active phases. The latent phase is the time when the cervix starts to efface and dilate up to 3 cm. While the active phase begins when the rate of cervical dilatation accelerates, which occurs at 4 cm to 10 cm [1]. Despite the fact that Bugando Medical Centre (BMC) is using the modified partograph; there are no management guidelines or protocols on how to manage pregnant women admitted in the latent phase of labour. In this study the low risk pregnancy was defined as any pregnant woman who had no medical problems associated with the pregnancy such as diabetes mellitus, epilepsy, anemia, hypertension, premature labor, previous caesarean section, multiple pregnancies, malpresentation and infections which present a potential risk to the baby. A study indicates that latent phase is a sensitive period that can be influenced by pregnancy and may in turn influence both active and the expulsive phase of labor [2]. Patients in labor are usually admitted to the hospital during the first stage of labor. It is important to differentiate between the active and latent phases because women admitted in latent labor tend to spend more time in the labor ward and have more interventions than those who are admitted during the active phase. When a pregnant woman is admitted during the latent phase of labor, physicians should set reasonable expectations for labor progress to avoid unnecessary interventions and anxiety [1]. The widespread use of routine medical interventions in labor is of worldwide concern [3]. Evidence demonstrates that management of early labor has an impact on maternal and neonatal outcomes, in which women who are admitted in the active phase of labor at 4cms or more cervical dilatation experience less interventions and complications than those admitted in the latent phase of labor with 3cms cervical dilatation or less [4]. Delayed-admission in labor may help to avoid premature and unnecessary intervention in women with prolonged latent phase. A study done by McNiven et al. showed that women who delayed admission while in labor had significant less oxytocin use compared with early admitted ones 40% versus 23%, and shorter duration of labor in hospital 13.5 hours versus 8.3 hours respectively but there was no significant differences in caesarean delivery and neonatal outcomes [5]. Possible reason for the increased rate of intervention is that prolonged latent phase may be misdiagnosed as a protraction or arrest disorder. Prolonged latent phase is associated with a higher risk of subsequent labor abnormalities, such as postpartum hemorrhage, chorioamnionitis and neonatal admission to the intensive care unit and long hospital stay [6]. Factors that may affect duration of the latent phase include unfavorable cervical condition, false labor, sedation and analgesia/anesthesia [5]. Women presenting in the latent phase of labor experienced more caesarean deliveries and active phase arrests of labor than women presenting in active labor. It is uncertain whether inherent labor abnormalities result in latent phase presentation and subsequent physician intervention or whether early presentation and subsequent physician intervention are the causes of the labor abnormalities [7]. Methods The study was a descriptive cross-sectional study conducted at Bugando Medical Centre (BMC) which is on the northwest side of Tanzania in the city of Mwanza from February to April 2013. The centre serves as a referral consultant hospital and as a University teaching hospital. The average number of deliveries is 600 per month and it caters primarily for high-risk pregnant women referred from peripheral hospitals and low risk pregnant women residing in Mwanza city. The study population included low risk pregnant women at term (gestation age 37–42 weeks) aging between 18–35 years, singleton pregnancy and cephalic presentation. Women with the following conditions were considered high risk and were excluded, this included women with multiple pregnancies, previous caesarian delivery, any other presentations different from cephalic, gestation age below 37 weeks, abnormal placentation recorded during antenatal care by ultrasonography, antepartum hemorrhage observed antenatally, and chronic medical conditions (hypertension, asthma, diabetes mellitus, epilepsy, anemia, HIV and sickle cell disease). Serial sampling method was used until a desired sample size was reached and the sample size for this study was calculated by using a formula for a difference proportions (equal sized groups). Latent phase of labour was defined as the interval from when the woman perceives mild regular uterine contractions up to when the cervical dilatation was 3 cm. The active phase of labor was defined as the interval after the latent phase to full cervical dilatation. Case notes of all eligible women were reviewed and the information extracted using structured checklist. Each case note and checklist was assigned an identification number. Information collected included socio-demographic characteristics and obstetric history such as gravidity, parity and gestational age; interventions such as artificial rupture of membranes, augmentation with oxytocin and caesarean section; maternal and neonatal outcomes including birth weight, APGAR score and admission to Neonatal Care Intensive Unit. Data was analyzed by using SPSS version 17. Categorical variables were summarized into proportions and percentages. Numerical data was summarized into means, median and standard deviations. Chi-square was used to compare the differences between the two groups for categorical variables while t-test was used for continuous variables. Odds ratio was calculated as a measure of the strength of the associations between variables. Ethical review and approval to conduct the study was obtained from the department of Obstetrics and Gynecology, Catholic University of Health & Allied Health sciences (CUHAS) and Bugando Medical Centre (BMC) Research Ethics Committee. The filled checklists were kept in secure place for confidentiality after data entry, cleaning and dissemination of results. Results During the study period 2,059 pregnant women delivered and of these 500(24.3%) met the inclusion criteria (250 in latent phase and 250 were in active phase of labor). Most participants had age ranging between 18–40 years with mean age of 25.42±5.25 years. Majority of women in both active and latent phases of labor were in the age group between 20–35 years 222(88.8%), and 208(83.2%) respectively and majority with only primary school education (179(71.6%), and 199(79.6%)) (Table 1). Table 1. Socio-demographic and Obstetric characteristics of parturients in latent and active phase of labor (N=500) Among the total of 500 women in the study, 354(71%) were primigravida 120(34%) admitted in latent phase and 234(66%) in active phase of labour (Table 1). Proportion of pregnant women who received key interventions including augmentation with oxytocin, artificial rupture of membranes and caesarean section were significantly higher in the latent phase group than in the active phase group 84(33.6%) versus 52(20.8%) p
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